Risk factors for unintentional medication discrepancies identified through pharmacy staff-led medication reconciliation to prioritise patients in the emergency department: a rapid review.

Abstract

Objectives: This study aimed to identify the risk factors associated with unintentional medication discrepancies identified through pharmacy staff-led medication reconciliation in emergency departments across multiple countries. The long-term goal is to support the development of a model to systematically prioritise patients at high risk in these settings.

Methods: This rapid review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A literature search of the PubMed database was performed on 8 October 2024. Studies were selected based on predefined eligibility criteria defined by the PICO framework- Population: adult emergency patients (aged ≥18 years) admitted to the emergency department; Intervention: medication reconciliation conducted by pharmacy staff; Comparator: standard medication reconciliation or standard care; Outcome: risk factors for unintentional medication discrepancies identified through pharmacy staff-led medication reconciliation in the emergency department. All included studies were qualitatively assessed.

Results: The literature search yielded 433 citations, of which 15 studies met the eligibility criteria. The included studies primarily investigated patient, medication and setting-related risk factors, encompassing a total of 15 264 patients who received pharmacy staff-led medication reconciliation in emergency departments across seven countries. A consistent pattern of risk factors emerged, including advanced age and polypharmacy. Only one study found that admissions during night-time or weekend hours were significantly associated with medication discrepancies. Differences in health IT systems and reconciliation practices were also noted across countries.

Conclusions: Advanced age and polypharmacy were consistently associated with unintentional medication discrepancies. Future research should address variations in health IT systems and focus on developing robust prioritisation models to optimise medication reconciliation processes and improve patient safety. Increasing pharmacy staff capacity may further support this goal.